188 | Chapter 8 which hinders effective socialization in practice (Chapter 2,3,5).11,12 For NQMs, the development process during the transition-into-practice period is based on random work experiences without individualized and formalized support or guidance from midwives as role models and mentors.13,14 Although we did not measure the performance of NQMs, research suggests that, without adequate support, the quality of care provided by NQMs for their clients may not meet the required standard.1,15 The level of competence of NQMs in client-centred tasks appears to be high immediately after graduation appeared to be high, but it is possible that a heavy workload and new roles and responsibilities may lead to uncertainty and unnecessary referrals to secondary care.16 The opportunity to review and discuss cases with fellow midwives is important in preventing this drop in quality.16,17 The lack of recognition from stakeholders for the need for NQMs to work in a stable work environment surprised us (Chapter 7). Stakeholders in midwifery recognized the need for NQMs to develop their competences in practice. At the same time, they underestimated the importance for NQMs to work in a stable work environment, close to fellow midwives. Organizational barriers may explain this lack of recognition. The current system of midwifery care in the Netherlands, with locum-working, self-employed NQMs,18 makes it virtually impossible for practice owners and managers to act as a responsible employer towards NQMs. According to labour legislation, practice owners are not allowed to act as employers towards locum midwives.19 They can only act as commissioners. Our findings show that the lack of collaboration with an experienced midwife, the lack of support from available midwifery colleagues, and working in temporary employment are highly demanding for NQMs (Chapters 2, 3). The percentage of exhaustion among NQMs is relatively high at 16%, meaning that a large number of NQMs are at risk of developing burnout symptoms.20 Providing NQMs with a stable work environment enables them to build solid relationships with clients and colleagues,5,21 provides them with opportunities to familiarize themselves with running a practice organization, and allows them to further develop the required level of competence under the guidance of experienced midwives (Chapter 7).13,14 According to our findings, emotionally rewarding job resources for NQMs are working “with women” and autonomy at work (Chapter 2,3,4). These findings appear similar to previous research on midwives’ wellbeing.22 The importance of these resources for Dutch NQMs needs to be recognized in midwifery practice. Dutch NQMs currently have to work in a changing organizational maternity care landscape.23 Regional protocols and
RkJQdWJsaXNoZXIy MTk4NDMw